Provider Demographics
NPI:1386395721
Name:MIDDLETON, CHARLES HUNTER
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:HUNTER
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 LAKELAND DR STE 401
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4607
Mailing Address - Country:US
Mailing Address - Phone:601-939-4230
Mailing Address - Fax:601-664-6694
Practice Address - Street 1:971 LAKELAND DR STE 401
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4607
Practice Address - Country:US
Practice Address - Phone:601-939-4230
Practice Address - Fax:601-664-6694
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily